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Using RTLS Data to Increase Ambulatory
Care Capacity
Session 53, February 12, 2019
Rodney L. Haas, VP Operations Excellence
University of Minnesota Physicians
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Rodney Haas, BS Mechanical Engineering
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• Overview of M-Health
• Real-Time Location System (RTLS) System Overview
• RTLS Case Studies
Agenda
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• Learning Objective 1: Describe how RTLS technology can be
leveraged to improve patient and care team experiences
• Learning Objective 2: Initiate organizational change by engaging
care teams with data
• Learning Objective 3: Create an environment of continuous
process improvement
Learning Objectives
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Vision:
• Innovative health care model implemented by interprofessional teams
• Patient experience extraordinary care and exceptional outcomes
• Education and research missions flourish
University of Minnesota Health
Clinics and Surgery Center
The Facility:
• 342,000 square foot
• 37 Adult Specialties
• Masonic Cancer Clinic &
Advance Treatment Center
• Lab, Imaging & Diagnostic
Services
• Retail Pharmacy
• Ambulatory Surgery and
Procedure Center
• Full Service Café
• Three-Story Staff Lounge
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• Maximize space (from 300 exam rooms to 178)
• Providers do not own space: flexible usage based on volume
• Only one waiting room per floor
• Patients are greeted by name
• No one waits more that 15 minutes past their appointment
Redesign the Delivery of Care
• 2,500 Unique Patient Appointments per day
• 1,500 staff members practicing at any time
• 10+ percent (%) growth per year since opening in 2016
RTLS supported the
design of the building with:
• Exam Rooms: 122 less exam
rooms
• Clinic Growth: 2016 > 2018 =
19% increase
RTLS supported the
design of the building with:
• Exam Rooms: 122 less exam
rooms
• Clinic Growth: 2016 > 2018 =
19% increase
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Care Connect (RTLS)
xxx
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Active Practice Management
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Patient & Staff Experience
Connecting with the Patient
• Patient concierge and rooming staff
locates the patient using the RTLS
display and photo in Epic Cadence
• Greets the patient by name, informs
them about their visit, and escorts the
patient to the exam room.
Wait Time Management
• If a patient is in the Waiting Room 15 min past their appointment time or in an Exam Room alone
for longer than 10 minutes, a popup will display at the Concierge Tablet
• If a patient is in the exam room and an alone time pop up occurs, the pop up is cleared by proximity
of a staff or provider badge
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Patient & Staff Experience
Background
1. RTLS data identified check-out portion of visit as a major source of wait time for Primary Care and
Urology clinics.
2. Frustrated patients skipped the check-out process, resulting in many critical follow-up appointments
not scheduled in timely manner.
Solution
1. Create a separate fast-track process (“Express Check-Out”) for patients with three or fewer follow-
up appointments.
2. Warm hand-off of patients between clinic staff and check-out staff
3. Patients who require complex check-out receive close monitoring on RTLS track board and
frequent update. Complex check-out patients do not become bottleneck points of the process.
% of pts who have all follow-up appointments scheduled prior to departure: 71% 93%
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Active Practice Management
Move from reactive problem
solving to anticipation of
issues
Manage Space & Flow
• No assigned provider rooms
• “First Room Up”
• Patients taken to available rooms
(green)
Providers use the RTLS
status boards to:
• Know exactly where to go
• Monitor how long patients visit and
experience
• Locate other care team members
and equipment
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Active Practice Management
Providers use the RTLS
status boards to:
• Know exactly where to go
• Monitor how long patients visit and
experience
• Locate other care team members
and equipment
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Results
Results
• Improve patient flow and
reduce wait times.
• Provide real-time data
about patient visits (ie.
room status, wait and
alone time alerts,
physician assist).
• Improve
communication and
coordination among
providers, staff, and
operation management.
RTLS has allowed us to better utilize
space while growing specialties:
• Utilization: 2016 > 2018 = 4% increase (36% to 40%)
• Clinic Growth: 2016 > 2018 = 19% increase
RTLS has allowed us to better utilize
space while growing specialties:
• Utilization: 2016 > 2018 = 4% increase (36% to 40%)
• Clinic Growth: 2016 > 2018 = 19% increase
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Quality & Safety
RTLS support the clinic staff by:
• Being able to understand the exposure risk in hours vs
weeks
• Communication with Staff and Patients on level of exposure
risk
• Locate the patient and minimize the risk of exposing others
RTLS support the clinic staff by:
• Being able to understand the exposure risk in hours vs
weeks
• Communication with Staff and Patients on level of exposure
risk
• Locate the patient and minimize the risk of exposing others
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Continuous Improvement
RTLS supports Quality &
Process Improvement
Activities
• Increases data sample size
• Decreases time to collect data
RTLS does not replace
Process Improvement
Activities
• Go & See / Time Study
• Value Stream & Process Mapping
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Using RTLS Data to build comprehensive simulation
models (Probability “Monte Carlo” Simulation)
What would happen if we change
the current scheduling structure?
Current Structure
Split Structure
Simulation Model
loaded with RTLS data
Potential Outcomes
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Using RTLS data to manage space utilization
and patient experience
Balanced
Approach
Balanced
Approach
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RTLS enables more complete process analysis
Significantly bigger
sample size compared
to manual data
collection
This is just one clinic for 6 months!
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RTLS data enables individual monitoring and
customized solutions
Prompted the conversations with Dr. “M” and adjustments of scheduling
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RTLS data enables us to identify true root
causes and optimal solutions
A clinic argued delays in the laboratory were causing patients to arrive after scheduled clinic
appointment time, disrupting provider schedules.
The clinic proposed to schedule lab appointment 2 hours (instead of 1 hour) prior to clinic
appointment to mitigate lab delays.
Patient 1: No lab prior to the clinic appointment. Arrived at CSC and 3
rd
FL on time
Patient 2: 5 minutes wait at Lab. Patient arrived at CSC 1 hour late.
Patient 3: 1 minute wait at Lab. Patient arrived in CSC only 12 minutes prior to the Clinic appointment
time. Still arrived at 3
rd
FL on time.
Patient 4: No lab prior to the clinic appointment. Pt. arrived at CSC only 2 minutes prior to the clinic
appointment.
Patient 5: No lab prior to the clinic appointment. Arrived at CSC and 3rd FL on time
Patient 6: No lab prior to the clinic appointment. Pt. arrived at CSC only 1 minutes prior to the clinic
appointment.
Patient 7: 1 minute wait at Lab. Patient had another appointment in 3 D&T. Still arrived at the clinic on
time
Patient 8: No lab prior to the clinic appointment. Arrived at CSC and 3rd FL on time
Patient 9: 4 minute wait at Lab. Arrived at CSC and 3rd FL on time
Patient 10: 13 minute wait at Lab. Patient could have arrived at 3
rd
FL on time, but for some reason, the
patient spent 21 minutes in cafeteria, arrived at clinic 26 minutes late .
Analysis of 500 patients
with significant clinic
wait time revealed that
the proposed solution
would be a very costly
one without much
impact
On average, 74 pts/day require lab prior to cardiology appointment:
74 hours of unnecessary pt. waiting, staff resources, space avoided!
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Continuous Improvement
RTLS – is key
tool in the
continuous
improvement
journey
